Anti-tNF and lymphoma

This is reassuring from ACR




Objective:
To conduct a national prospective study to collect all cases of
lymphomas occurring in patients treated with anti-TNF in France during
2 years.
Methods:
A prospective cohort study involving 486 clinical departments in
France was designed by a multidisciplinary group (RATIO) to describe
lymphomas occurring in patients treated with anti-TNF. In accordance
with national health authorities, all these cases were notified to
RATIO. All the specimen of lymphomas were validated by an expert
committee, reviewed by the same hematopathologist and assessed for
Epstein-Barr virus (EBV) presence.
We made a case control study (controls paired on the underlying
disease, age and gender) For each case, we included 2 controls, 1
treated with anti-TNF without any complications and the other not
treated with anti-TNF.
Different mode of calculation estimated at around 30,000 the number of
patients treated with anti-TNF in France in 2004 and 2005 with 2/3 of
women and 1/3 of men and a mean age of 56 years. The age and
age-adjusted incidences of Hodgkin’s lymphoma (HL) and Non Hodgkin’s
lymphoma (NHL) were calculated by direct standardization and the
Standardized Mortality Ratio (SMR) for lymphoma were calculated with
the French population as reference
Results:
We report 16 cases of lymphoma that occurred within 2 years (9 cases
with infliximab, 4 with adalimumab, 3 with etanercept). Indication for
use was RA in 11 cases, ankylosing spondylitis in 2 cases, Crohn’s
disease in 2 cases and primary Sjögren’s syndrome in 1 case. Ten
patients were men. Median age was 57 years. Median time between
beginning of anti TNF-alpha treatment and lymphoma was 23 months
(range 4 to 49). Twelve patients have received also methotrexate, 3
leflunomide, 2 azathioprine.
Histologic subtypes were heterogeneous: 3 HL all in men RA patients, 7
diffuse large B-cell NHL, 2 MALT B-cell NHL, 1 immunoblatic B-cell
NHL, 3 pleiomorphic T-cell NHL and 1 lymphoblastic T-cell lNHL. EBV
was detected only in 1 HL.
The case-control study did not identify any peculiar risk factor in
patients developing lymphoma after anti-TNF.
The age adjusted incidence rate was 10.2/105 PA for HL in men, 0/105
PA for HL in women, 19.7/105 PA for NHL in men, and 12.9/105 PA for
NHL in women. The SMR were 5.13 (p=0.20 ), 0 (p= 0.39 ), 0.96 (p=0.93
) and 0.64 (p=0.39 ) for HL in men, HL in women, NHL in men, NHL in
women respectively.
Conclusion:
This first national prospective study including 16 cases all validated
and reviewed by the same hematopathologist suggest than anti-TNF do
not increase the incidence of lymphoma compared with the general
population except a slight increase of risk of HL only in men, a
feature already found in RA patients treated with MTX.

that IS encouraging. thanks for sharing.

diane